Many patients with chronic conditions have difficulty adhering to prescribed therapies. In general, the more medications taken and the more times each day that patients must use various therapies, the more likely there will be a medication error. Often patients have co-morbid conditions that interfere with their adherence to medication regimens. These conditions may include diabetes and associated complications such as blindness or lack of mobility, various neurological conditions and dementias, arthritis and associated difficulties in manipulating devices, and other debilitating conditions. The interactions of various co-morbidities can bring additional complexity and dynamism to medication regimens. Cognition also generally declines with age. Consequently, elderly patients may experience difficulty filling and organizing their medications, and remembering to take them as prescribed. These problems are widely recognized, but there have been no cost-effective solutions to date.
Most medication taken at home is in oral form: solid pills, tablets, and gel capsules. Treatments for the chronically ill are typically composed of several, if not many, different medications. For example, congestive heart failure (CHF), a common condition in adults over the age of 50, often requires patients to take 8 or more prescription medications. Such multiple medications come in different dosages, and are prescribed to be taken at different intervals during the day. This combination of large number of pills and remembering various administration times makes a complex medication regimen—polypharmacy—difficult for patients to manage and follow. It should also be remembered that these patients may even have a hard time with a simple regimen due to their advanced age or due to an implicit cause of their condition. Difficulties can occur both when pre-arranging the daily regimen and at the time of taking the dosage. The wrong pills can be prepared to be taken at the wrong time, in the wrong dosage, or pills may not be taken at all. Even with careful planning, come administration time, the medication can still be forgotten and missed. Worse, polypharmacy treatments can be composed of medications that can interact and lead to complications for instance, when episodic medications are added to treat acute conditions.
In the past decade, the increase of polypharmacy regimens has led to a correlating increase in non-adherence and thus, a resulting increase in complications, disease severity, and even death. The societal costs associated with medication non-adherence have been estimated to be in the hundreds of billions of dollars.
Consequently, solutions have been proposed to alleviate the problem. These solutions include devices that assist the patient with arranging the medication in predetermined groups to be taken together and reminders to take the medication at the correct time. In the U.S., to simplify the situation and based on clinical evidence, a standardization of the times during the day when medications are to be taken has even been developed and implemented.
Examples of devices that assist the patient with prearranging the oral medications include pill boxes and pill sorters such as the MedMinder Pill Dispenser, the Philips Lifeline, and the Compumed Medication Dispenser. Small pill caps are also now available which can be mounted on top of regular pill bottles to alert the patient that it is time to take the medication. Some of these devices also log the event of the patient taking the medication (or missing it, as it might be). This is accomplished via capturing a proxy event, in most cases the opening and closing of the pill compartment or pill bottle. Smartphone apps have also been developed to help remind the patient that it is time to take the medication, and to communicate with the patient's caregivers, family, friends, clinician that the medication has or has not been taken at the right time.
While such devices and apps have been developed with the same aim, to help reduce the non-adherence problem, they fail to provide a comprehensive solution to helping the patient on a polypharmacy treatment adhere to the complex regimen. Some of the existing solutions provide assistance with manual filling, but do not allow for automated sorting of the pills if the patient is dependent on others to organize their medications. One such example is the MedMinder device. Some other solutions provide pill counting functionality, but do not operate with multiple pills at the same time. One such example is the Kirby unit. Still other solutions include simple timers with alarms, such as the Reminder Rosie. Other devices, such as the GlowCap remind the user to take the medicine contained in a single pill bottle, but cannot provide sorting assistance or serve a polypharmacy regimen with a single device.
Accordingly, a need exists to develop a comprehensive, end-to-end solution that provides the patient with assistance in sorting the complex regimen into multiple daily doses, reminds the patient when it is time to take the medication, easily dispenses the specific dose, and provides clear instructions related to the treatment.